THE MOST important thing to know
about colon cancer screening is that you
need to do it and do it regularly, starting at
age ;;. Colon cancer, which is also called
colorectal cancer (CRC) and includes cancer of the rectum, is the second leading
cause of cancer death in the United States,
according to the Centers for Disease
Control and Prevention (CDC; cdc.gov).
However, it is almost completely preventable through regular screening, says Dr.
David Greenwald, director of clinical gastroenterology at Mount Sinai Hospital in
New York City.

“When we screen for colon cancer,
we’re looking for polyps, which are pre-cancer. If we find any, we can remove them
before they turn into cancer, so we have an
opportunity to prevent cancer from ever
developing,” explains Greenwald.

So why is CRC still a leading cause of
cancer death if it’s mostly preventable?
Because, even though screening rates for
colon cancer have increased over the last
decade, a third of the population eligible to
be screened doesn’t do it.

Barriers to screening include fear,access, money and time. Fortunately, moretests are available than ever before to helpbreak down these barriers. The UnitedStates Preventive Services Task Force(USPSTF; uspreventiveservicestaskforce.org) issued new CRC screening guidelinesin ;;;;, which recommended morescreening tests than the ;;;; guidelines,including easy-to-use stool-based tests.

“The key to any screening test is that
you want it to be easy, efficient and effective. I think the options that are out there
are all good,” says Dr. Christopher Lieu, a
Costco member and director of gastrointestinal medical oncology at the University
of Colorado Cancer Center.

Screening options

The USPSTF recommends regular
screening from age ;; until ;; for people
who have an average risk. People who are
over ;; or who have high-risk factors, such
as a family history of CRC, or an inflammatory bowel disease such as Crohn’s or
colitis, should consult their doctor about
the right screening schedule for them.
Some screening tests look for polyps and
early signs of colon cancer, while others
mainly look for signs of cancer.

Tests that detect both polyps and cancer include:

Colonoscopy. This procedure is the
most commonly used for colon cancer
screening, says Greenwald, because the
person performing it is able to detect polyps and remove them at the same time.
During this test, a specialist looks at the
entire colon and rectum while you’re under
sedation. A negative result means you’ll

Flexible sigmoidoscopy. This test is
similar to a colonoscopy, but a specialist
looks at only the left side of your colon,
where most colon cancers lurk. Sedation is
usually not necessary. Lieu says that if you
opt for a sigmoidoscopy, which you should
do every five years, you should also do a
stool-based test every year or two to maximize the chances of cancer detection. Also,
if polyps or cancer are detected, you’ll
need a colonoscopy so a specialist can
examine the rest of the colon.

Computed tomography (CT) colonogra-phy (aka virtual colonoscopy). A specialist
uses X-ray images and a computer to look
at your entire colon. Rarely will you need
sedation. If no abnormalities are detected,
you should do this test every five years. If
a polyp or cancer is detected, you’ll need
a colonoscopy.

Stool-based tests. These tests are less
expensive, less invasive and don’t require
any bowel prep or sedation. However, if
you get an abnormal result, you’ll need a
colonoscopy. “If you get a positive result
and don’t follow up with a colonoscopy, it’s
an inadequate screening,” warns Greenwald. Stool-based tests include:

• Fecal immunochemical test (FIT) and
guaiac-based fecal occult blood test
(gFOBT). With these two tests, a stool sample is taken at home and sent to a lab for
analysis. While these tests are more convenient because you can do them at home,
you need to do them annually to maximize
their effectiveness.

• Stool DNA (aka FIT DNA). This newer
test (approved by the Food and Drug
Administration in ;;;;) combines a FIT
and a test that looks for altered DNA in
your stool. “Abnormal pieces of DNA are
the building blocks for cancer cells,”
explains Greenwald. According to the
American Cancer Society ( cancer.org), a
negative result means you can repeat it
every three years, as opposed to annually.

Which test is right for you?

While a colonoscopy is considered by
many to be the gold standard of CRC
screening, a less invasive test may be a better choice for you, especially if you can’t
tolerate sedation well or have a serious
health issue. You should speak to your doctor about your health history, your preferences and your insurance coverage to
figure out the best screening option.

“Choosing any of them is the right one
because you’re getting screened,” says
Lieu. C